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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 28. This is the beginning of the thread.
Posted by OneWing on April 20, 2010, at 0:17:20
Sorry about the length of this.
A few years ago, I started seeing a therapist for depression, anxiety and social issues. I was soon put on Cymbalta, and the dosage was increased with no effect on my depression. I was then switched to Zoloft, which also had no effect, no matter the dosage. I was then moved to Wellbutrin, and now I'm on Lexapro. Nothing is working or me. I know a pill won't magically help me, but there has been no effect by these pills. I've seen 4 therapists (went to college, switched colleges etc, wasn't purposefully changing therapists), and also have really not stopped hating myself any less than I did. I think I can say that I hate myself more now. I'm not suicidal though, just self-deprecating. I've stopped therapy because of this, and my most recent therapist (when I told her I was stopping) basically explained to me how therapists can't really do anything but listen and provide information, and the change has to come from within. She suggested I start doing something creative. I can't believe I've spent so much money just for this answer.
So my question is, what now? What can I do? What can I take? I hate being stuck like this, I can't even look in the mirror an not despise everything I see in it.Little background:
I have sleep issues (sleeping pills don't work more than 3 days, I easily adjust to them, out of brands) and chronic joint, neck and back pain. I've been on a pharmacy of pills for all this, physical therapy, behavioral therapy, you name it I've tried it. Nothing seems to help me. I think it's possibly somatic, which means I'm screwed anyways in looking for a cure.
Posted by Deneb on April 20, 2010, at 1:19:24
In reply to I've Tried Everything, posted by OneWing on April 20, 2010, at 0:17:20
Hello OneWing!
Welcome to Psycho-Babble! It sure seems like you've tried a lot of things to help yourself. It's too bad none have helped you. Don't give up, there are many people in the same boat as you here on Babble. It's called treatment resistant depression and it is a hard illness to live with. It's very good you are not suicidal.
There have been stores of people finally finding the right combination of meds after years of suffering. It is possible to get better. It takes a lot of patience and some luck to find something that works.
MAOI's are one of the most effective anti-depressants out there. Have you given any thought to them?
Deneb
Posted by Zyprexa on April 20, 2010, at 5:54:49
In reply to I've Tried Everything, posted by OneWing on April 20, 2010, at 0:17:20
I've tried all kinds of antidepressant and none of then helped anxiety. You should try a different kind of pill. What I use is zyprexa. Great for sleep and anxiety. Take that with a AD. Wellbutrin usualy makes anxiety worse, unless you take it with zyprexa.
Posted by Phillipa on April 20, 2010, at 10:46:09
In reply to Re: I've Tried Everything, posted by Zyprexa on April 20, 2010, at 5:54:49
Did your first AD work for you? The very first? As seems that for some like me only the first Ad works and if you stop the med none work again. Yes I gave up on therapists a long time ago. Just never seemed to understand or help. I wish you luck. Phillipa
Posted by OneWing on April 20, 2010, at 12:11:20
In reply to Re: I've Tried Everything, posted by Phillipa on April 20, 2010, at 10:46:09
My first AD, Cymbalta, had no effect. My depression got much worse when I started taking it, although it was also environmental factors that caused the depression to worsen.
Posted by evenintherain on April 20, 2010, at 13:21:30
In reply to Re: I've Tried Everything, posted by OneWing on April 20, 2010, at 12:11:20
There are lots of people on this board in similar situations to you (including me), some of whom might be able to help you find some really useful answers.
I haven't been successful with therapy either, I don't think I understand how to do it. Also there are a lot of crummy therapists, or ones that don't suit everyone, so it takes a lot of time and money and luck getting one that will be helpful. That's my impression at least.I seem to have similar symptoms to you (trouble sleeping and treatment resistant depression). I got a little bit of relief for a few years taking a combo of Celexa and Lamictal. Have you ever augmented your AD with anything? This seems to be a popular option and there are a lot of things to choose from (mood stabilizers, other AD's, atypical anti-psychotics...)
have you tried any of the following?:
Prozac
Wellbutrin
Abilify
Amisulpride
Risperidone
Geodon
Seroquel
Zyprexa
Neurontin
Agomelatine
Savella
Parnate
Nardil
Marplan
Segeline
Nortriptyline
Clomipramine
Ritalin
DexadrineSome of these drugs can be used as monotherapy, and some have to be taken together. If there are some on there you haven't tried, i suggest searching the archives here. You may have more options than you thought!
Posted by OneWing on April 20, 2010, at 13:41:50
In reply to Re: I've Tried Everything » OneWing, posted by evenintherain on April 20, 2010, at 13:21:30
I've tried Wellbutrin, Neurontin (for pain), and Ritalin. How do essentially tell a psychiatrist to put you on a specific drug? It doesnt seem ethical to me?
Posted by mellow on April 20, 2010, at 14:00:30
In reply to I've Tried Everything, posted by OneWing on April 20, 2010, at 0:17:20
Welcome to babble, i'm sorry you aren't feeling well. I think most of us have been there at some point. Some of us are still there. This is a wonderful place to get support and gain knowledge.
Have you considered starting from scratch with a new doctor? Have you researched some psychiatrists in your area who maybe also specialize in neurology or pain management?
The right doc is key. Someone who can review you from all the angles and help you experiment with what drugs are going to bring you out of this hole. What your last therapist said is very true. They can't make you stop hating yourself. They can only provide a supportive environment so you can walk through your past traumas and current situation to find some peace. Self hatred isn't a good place to be and for me it was only resolved once i found the right mix of meds and was stable enough to really do some hard work in therapy and realize how flawed my thinking was.
I wish you the best of luck. Please continue to post and let us no how you are doing!
mellow
> Sorry about the length of this.
> A few years ago, I started seeing a therapist for depression, anxiety and social issues. I was soon put on Cymbalta, and the dosage was increased with no effect on my depression. I was then switched to Zoloft, which also had no effect, no matter the dosage. I was then moved to Wellbutrin, and now I'm on Lexapro. Nothing is working or me. I know a pill won't magically help me, but there has been no effect by these pills. I've seen 4 therapists (went to college, switched colleges etc, wasn't purposefully changing therapists), and also have really not stopped hating myself any less than I did. I think I can say that I hate myself more now. I'm not suicidal though, just self-deprecating. I've stopped therapy because of this, and my most recent therapist (when I told her I was stopping) basically explained to me how therapists can't really do anything but listen and provide information, and the change has to come from within. She suggested I start doing something creative. I can't believe I've spent so much money just for this answer.
> So my question is, what now? What can I do? What can I take? I hate being stuck like this, I can't even look in the mirror an not despise everything I see in it.
>
> Little background:
> I have sleep issues (sleeping pills don't work more than 3 days, I easily adjust to them, out of brands) and chronic joint, neck and back pain. I've been on a pharmacy of pills for all this, physical therapy, behavioral therapy, you name it I've tried it. Nothing seems to help me. I think it's possibly somatic, which means I'm screwed anyways in looking for a cure.
Posted by evenintherain on April 20, 2010, at 14:10:32
In reply to Re: I've Tried Everything, posted by OneWing on April 20, 2010, at 13:41:50
I haven't ever asked for a specific drug by name (though i haven't been doing my own research for very long, and I am relatively timid). You're right, this could probably turn some psychiatrists off (they might think you're drug seeking, or it may hurt their ego). But sometimes you can bring in evidence for why you think certain drugs might help (people on here will link to studies, etc) and it seems like it wouldn't be ethical for them to completely ignore your suggestion. Someone else mentioned MAOI's, and it's true, lots of doctors know next to nothing about these drugs though they have been shown to be some of the most successful anti-depressants. This is because the drug companies are not pushing them (they are old and all generic by now, so aren't money-makers), and because they require the patient to adhere to a special diet and avoid certain contraindicated drugs or a dangerous reaction could occur. So, in other words, they are covering their behinds.
Frankly, I think it is unethical for the doctors to ignore requests for MAOI's in light of all the seemingly treatment-resistant people who get wonderful results from these drugs.
Posted by atypical on April 20, 2010, at 14:27:02
In reply to I've Tried Everything, posted by OneWing on April 20, 2010, at 0:17:20
I'm sorry about your troubles. It seems, though, you've just scratched the surface of your treatment options. There's Effexor, an SSRI/SNRI. There's the tricylic antidepressants, the MAOIs, there are some antipsychotics that help depression. Augmentation with lithium. Then there are thyroid meds. And fish oil supplements. Who knows -- perhaps there is a deficiency of some sort. Find a good psychiatrist who does medication primarily. Get blood work done. You have options. And even if these fail you have TMS and ECT. I've done just about everything here and am stable and well most times.
Good luck and keep on keeping on.
Atypical
Posted by OneWing on April 21, 2010, at 1:14:38
In reply to Re: I've Tried Everything, posted by atypical on April 20, 2010, at 14:27:02
Thank you all for your posts. I think ECT and TMS are a bit extreme though. Can anyone link the MAIO studies? What kind of diet do they require?
Posted by bleauberry on April 21, 2010, at 18:02:44
In reply to I've Tried Everything, posted by OneWing on April 20, 2010, at 0:17:20
If "evrything" is the meds you listed, then no, you have not tried everything. Actually, you haven't even tried 10% of options.
When zoloft wasn't working, the single best thing that should have been done at that time was to add Nortriptyline to it. Not to switch to something else.
Ask for Parnate. Then they'll know you are serious about getting better.
Having failed the meds you have failed, you now qualify for an MAOI.
Posted by evenintherain on April 22, 2010, at 0:35:01
In reply to Re: I've Tried Everything, posted by OneWing on April 21, 2010, at 1:14:38
> Can anyone link the MAIO studies? What kind of diet do they require?
I suggest you use the search function at the bottom, as there is a huge amount of info on this site to sift through. Try searching for Parnate or Nardil.
The diet involves avoiding food that are aged or fermented, most notably cheeses.
Here is a helpful post regarding the MAOI diet:
http://www.dr-bob.org/cgi-bin/pb/mget.pl?post=/babble/20010804/msgs/73614.html
Posted by bearfan on April 23, 2010, at 15:58:28
In reply to Re: I've Tried Everything » OneWing, posted by evenintherain on April 22, 2010, at 0:35:01
Are the MAOIs really that much better than everything else? I've seen a few reports where people that try MAOIs don't get much better than other therapies they tried.
Posted by chujoe on April 28, 2010, at 14:29:19
In reply to Re: I've Tried Everything, posted by bearfan on April 23, 2010, at 15:58:28
Hi OneWing (great handle, btw, we've all felt that way at one time or another). I'm fortunate in that my depression & anxiety have responded pretty well to a combination of medication and meditation, so I'm not going to offer any advice about specific meds, but I have a piece of psychological advice that may sound as lame as that of the therapist who told you to try something creative. Don't be passive; don't let yourself fall into "learned helplessness." Take an active role in seeking the right doctor or combination of doctors -- in my case, that involved a psychiatric nurse practitioner & a neurologist. Once you find that combination of docs / meds, who knows? You may want to try something creative -- sounds lame when you're sick, but I have found that getting focused on something outside myself helps keep me stable. Good luck and don't give in to passivity.
Posted by Laney on April 28, 2010, at 17:42:51
In reply to Re: I've Tried Everything, posted by chujoe on April 28, 2010, at 14:29:19
Chujo,
How did you approach seeing a neurologist? Why that route? Just curious. I mean wouldn't they refer you back to a Pdoc or Psychiatric Nurse?
Thanks,
Laney
Posted by chujoe on April 29, 2010, at 17:51:48
In reply to Re: I've Tried Everything, posted by Laney on April 28, 2010, at 17:42:51
Hi. I was referred to the neurologist by a psych nurse practitioner because I developed a pretty bad tremor on sertraline, so switched off that and onto cymbalta. Tremor is less but still present, though not enough to make me want to take mertazapine, which is what the neurologist suggested because it's also an AD and anti-anxiety drug, which are my two psych issues. They tell you up front that mertazipine will cause weight gain & that's a problem for me anyway -- I would have been happy on the Anxiety Diet, except for, you know, the anxiety. The NP wanted to get a baseline neuro exam -- I'm 59, so ruling out Parkinson's was also an issue. Thanks for asking!
Posted by tonyz on May 3, 2010, at 15:29:14
In reply to I've Tried Everything, posted by OneWing on April 20, 2010, at 0:17:20
Hi One Wing,
I don't have much else to offer than what has already been posted, but after reading your struggles I felt compelled to respond.I believe that many doctors that have been around for a while tend to favor some of the older anti-depressants, the tricyclics and the MAOIs. From the list of things you've taken, it doesn't appear you've tried these.
I've been on both at different times in my life. There are more side effects and a few things to watch out for, but they are manageable. Someone has already posted info about the MAOIs so there is no need to go into the dietary restrictions.
I wonder have you ruled out any potential physical problems, thyroid, mineral deficiencies, etc.
Lastly, I don't know if your depression is also characterized with anxiety, but if that is the case in addition to meds you might try meditation. It can help. You can just start off 5-10 minutes and gradually increase the time to 20-30 minutes. For me, staring at a candle flame seems to work best with eyes partially closed. I just try to focus on my breathing and not focus on any thoughts. As thoughts occur you try to release them and let them pass by. You are essentially trying to blank your mind. Consitency is also important, try to do it every day. Others may have a different approach to meditation.
Posted by chujoe on May 3, 2010, at 15:55:39
In reply to Re: I've Tried Everything, posted by tonyz on May 3, 2010, at 15:29:14
I agree about meditation -- my method is a little different, but it amounts to the same thing, quieting the mind. And consistency is the key: if you do it, do it every day, even twice a day. Think of it as medicine. Last summer for several weeks while I was waiting to see a psychiatrist -- I live out in the sticks, not many pdocs around here -- meditation helped me get through the worst of a huge resurgence of anxiety. Now, even though I'm on Cymbalta and the anxiety is under control, I find meditation very calming -- the effects extend out from the meditation period and into the rest of my life.
Posted by tonyz on May 5, 2010, at 13:45:15
In reply to Re: I've Tried Everything » tonyz, posted by chujoe on May 3, 2010, at 15:55:39
Would you mind sharing your approach to meditation?
Posted by chujoe on May 5, 2010, at 22:52:51
In reply to Re: I've Tried Everything, posted by tonyz on May 5, 2010, at 13:45:15
It's basic Zen meditation. I had been circling around Buddhism for a decade and finally this last time I tipped over into anxiety, along with meds and psychotherapy, I got serious about Buddhist meditation. There are a lot of good books out there for beginners and the audio guided meditations by John Kabbet-Zinn are really helpful. I can list a few titles if you're interested. Perhaps I'll put something over on the Alternative board tomorrow.
I find that meditation gives my meds a chance to work -- it clears out the static in my head, at least sometimes. I try to sit & meditate twice a day, once in the morning and once in the evening for 20 to 30 minutes. The meditation itself involves sitting quietly with eyes open and concentrating on the breath. Some teachers say to count your breaths from one to ten and then repeat, some just say to watch your breath and focus on it to the exclusion of other things. It's natural for thoughts to come up while you're doing this, but one is told to just let them drift by like clouds, to not get involved with them. It's harder than you think it will be and it takes practice and patience, but I've found it very helpful.
I'll post something more coherent tomorrow over on the Alternative board. Thanks for asking.
Posted by Hombre on May 6, 2010, at 1:13:17
In reply to I've Tried Everything, posted by OneWing on April 20, 2010, at 0:17:20
I found this site very informative, even if you don't have connective tissue problems (pain). This lady has put a lot of pieces together and has some great info:
http://www.ctds.info/index.html
Otherwise, keep trying different meds and try to reset your expectations to zero each time. It can be a series of "no, no, no..." until you hit "YES!".
Posted by tonyz on May 6, 2010, at 10:27:15
In reply to Re: I've Tried Everything » tonyz, posted by chujoe on May 5, 2010, at 22:52:51
thanks chujoe
Posted by Jeroen on May 8, 2010, at 15:47:32
In reply to I've Tried Everything, posted by OneWing on April 20, 2010, at 0:17:20
ive tried SSRI and they didnt work either,
then i tried Seroquel and worked magically for 2 months i took 100 mg
now that everything is pooped out, i am going to try Glycine Therapy, starting monday evening
wish me good luck
Posted by SLS on May 8, 2010, at 17:43:21
In reply to Re: I've Tried Everything, posted by Jeroen on May 8, 2010, at 15:47:32
> now that everything is pooped out, i am going to try Glycine Therapy, starting monday evening
What exactly are you trying to accomplish? What needs to be fixed?
> wish me good luck
I always do.
- Scott
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